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Researchers Examine Whether A Focus On Social Needs Keeps People From Getting Sick

NOEL KING, HOST:

When we talk about health care, we take it to mean treating people when they get sick. But some public health officials say we should help people meet other needs like food and housing. And then they will be less sick less often. But does that actually work? Here's Sojourner Ahebee of WHYY.

SOJOURNER AHEBEE, BYLINE: The emergency room at Temple University in Philadelphia was like a second home for Rita Stewart (ph).

RITA STEWART: I had the flu. I had pneumonia. But I'm a baby. Anything that happens to me - if I fall or scratch or scrape a leg, I'm going to the hospital, you know? That's the type of person that I was.

AHEBEE: But Rita, who is 53, is managing some serious illnesses like depression and a heart condition. And for many years, she used drugs. Her income was unstable. And she bounced between friends' homes and drug recovery houses. At one recovery home in Philadelphia, she says it was easy to get sick.

STEWART: I think I caught the flu or pneumonia from someone. It was four of us to a room. And someone that I was in the room with was already sick.

AHEBEE: The hospital became a go-to for a sense of stability and personal space. She got her own room and special care from doctors. Temple Hospital has identified hundreds of patients like Rita, people who get their care through Medicaid, who have unstable housing and who often make avoidable, expensive trips to the emergency room. Last summer, just as Rita was about to hit the six-month limit for staying in her latest recovery home, she got a call from a program called Housing Smart. The program works with Temple Hospital and offered her a free apartment. Rita remembers the day she got the call.

STEWART: I said, what? Housing people are on the phone for you about a place. I was like - it was like a dream.

AHEBEE: Last year, Temple and its health insurance partners offered a place to live to 25 patients who were homeless or housing insecure and showing up to the hospital a lot. The hope was that the stable housing would help improve their overall health and lower their hospital costs. Less than a year later, as Rita sits on the floor of her second-floor apartment, she says she's feeling healthier, supported and is generally taking better care of herself. The one bedroom is small but warm. There's a beige couch and a TV where she likes to relax.

STEWART: It feels really good just to be able to breathe again, to have that ultimate privacy and that space, you know, again, and my peace of mind.

AHEBEE: And Rita has not been back to the ER. This innovative housing program is part of a larger movement pushing health systems to pay for overall health, not just health care. Jaya Aysola leads the University of Pennsylvania's Center for Health Equity Advancement. She says doctors are trained to treat conditions like hypertension and diabetes. But they're not usually trained to also think about how racial and economic factors contribute to housing problems and chronic disease.

JAYA AYSOLA: Perhaps they self-identify as Black and they've been discriminated in the housing sector because of redlining. So by the time you're seeing them at your clinic, there is a myriad of social systems that have acted in concert with each other to set the stage for this person to be more at risk and have a disadvantage to another person. And the question is, when we ignore that, what happens?

AHEBEE: Among the 25 patients in Temple Hospital's Housing Smart program, emergency room visits have dropped dramatically - by 75%. But new studies of these programs present a mixed picture. For instance, health researchers at the University of Pennsylvania gave out free rides to some of the poorest patients at its health clinics. But Krisda Chaiyachati, who led the study, says the free transport didn't end up reducing no-show rates.

KRISDA CHAIYACHATI: When you just offer transportation, everybody makes a huge assumption that that's the only thing that they need to really get out of poverty or be able to access care. But in reality, there's actually so many other dimensions in any given day or any given week. One of those dimensions may matter more than the other.

AHEBEE: That's been true for Rita Stewart. It's not just the apartment that's made the difference but all the additional wraparound services. Rita was paired with several caseworkers who help her with government assistance, rent and utilities, the whole gambit

STEWART: I called Dion (ph) about - sometimes - like today, she bought me a bag of toiletries. They pick you up for your rides for your appointments, you know? You can't get it no better than that, honey.

AHEBEE: Yes.

STEWART: Door to door service - we're more like a family.

AHEBEE: Among the programs designed to tackle social needs, that kind of full-circle support is rare. And when it happens, it's expensive. In Philadelphia, Housing Smart costs $28,000 per year for each person. Researcher Jaya Aysola says that investment is worth it if it's done well.

AYSOLA: If you don't solve the root causes, we will always continue to invest short-term dollars in an unending cycle of remediating and navigating the current systems that are all broken.

AHEBEE: Skeptics and supporters of these programs say the health outcomes need to be monitored over years to truly know if these interventions outside the doctor's office can help improve health and lower costs.

For NPR News, I'm Sojourner Ahebee in Philadelphia.

(SOUNDBITE OF YONDERLING'S "WEST WINDOW")

KING: That story came from NPR's partnership with WHYY and Kaiser Health News.

(SOUNDBITE OF YONDERLING'S "WEST WINDOW") Transcript provided by NPR, Copyright NPR.